ERCP和EST在LC术前术后的应用价值  

The application value of ERCP,EST before and after LC

作　　者：孙振兴[1] 许国铭[1] 李兆申[1] 邹多武[1] 王娜[1] 田青[1] 姚银珍[1] 吴仁培[1] 张梅勤[1] 

机构地区：[1]第二军医大学附属长海医院消化内科,上海200433

出　　处：《肝胆胰外科杂志》2002年第2期80-81,共2页Journal of Hepatopancreatobiliary Surgery

摘　　要：目的 :探讨逆行胰胆管造影 (ERCP)检查及十二指肠乳头切开 (EST)对LC术前术后的诊治价值。方法 :先对 2 82例患者 (LC术前 2 17例 ,LC术后 6 5例 )行ERCP检查 ,发现总胆管结石后插入切开刀 ,将乳头切开 1.0～ 2 .0cm长 ,<1.0cm的结石直接用取石篮取出 ,>1.0cm的结石先用碎石器将结石粉碎后再取。结果 :2 82例中胆管显影 2 71例 ,显影率为 96 .1%。LC前ERCP成功的 2 0 6例中 ,除发现胆囊结石外 ,另发现总胆管结石 12 0例 ,乳头炎性狭窄 18例 ,肝内外胆管结石 13例 ,胆总管癌 2例 ,胆总管囊肿 2例 ,胆囊管低汇流 9例。LC后 6 5例中ERCP发现总胆管结石 32例 ,乳头炎性狭窄 2 4例 ,胆管损伤 5例 ,胆管癌 1例 ,正常 3例。本组行EST172例 ,14 8例总胆管结石中 14 4例取石成功 ,取石成功率为 97.3%。结论 :ERCP和EST在LC前后的应用 ,对于进一步明确诊断、选择手术方式、预防LC的并发症和提高LC的成功率具有重要价值。Objective:To evaluate the role of Endoscopic retrograde cholangiopancreatography(ERCP) and Endoscopic sphincterotomy(EST) before and after Laparoscopic cholecystectomy(LC).Methods:282 cases of ERCP were performed before LC(n=217) and after LC(n=65).Results:The success rate of ERCP was 96.1%(271/282). Besides the gallbladder stone,other diseases of common bile duct were found in 164 cases by ERCP,including the common bile duct stone,inflamated stenosis of papilla,low junction of cystic duct and so on. EPT was performed on 172 cases with common bile duct stone and inflammated stenosis of papilla. The clearance rate of stone was 97.3%(144/148).Conclusion:ERCP and EST before and after LC is very important in making the diagnosis,selecting the model of cholecystectomy,preventing the complications of LC and enhancing the success rate of LC.

关 键 词：胆管造影术 十二指肠乳头切开 胆囊切除术 腹腔镜 ERCP EST LC术 

分 类 号：R657.4[医药卫生—外科学]